Propensity score matching analysis of perioperative outcomes during Hub&Spoke training program in hepato-biliary surgery

This study aims to verify the safety and effectiveness of complex surgical procedures like hepato-pancreatic and biliary (HPB) surgery also in General Surgery Units when performing an Hub&Spoke Learning Program (H&S) with a referral center. This approach leads reduction of health migration and related costs for patients and health system granting the same standard of medical and surgical care in Spoke Units. Implementation of H&S through a retrospective analysis of prospectively collected database comparing, after a Propensity Score Matching (PSM) analysis, baseline characteristics and peri-operative outcomes of patients undergone HPB surgery in a referral center (Hub) and in three peripheral centers (Spokes) under the mentoring program. Hub Hospital was represented by the Hepatobiliary and Pancreatic Surgery Center in Pineta Grande Hospital (Castel Volturno, Caserta, Italy), while the Spoke Units were the General Surgery Unit of Padre Pio Hospital (Mondragone, Caserta, Italy), the General Surgery Unit of C.T.O. Hospital (Naples, Italy) and the General and Emergency Surgery Unit of A. Cardarelli Hospital, University of Molise (Campobasso, Italy). During the partnership program, from January 2016 to June 2023, H&S enrolled 298 and 156 consecutive patients respectively. After PSM, data of 150 patients for each group were analyzed. After PSM no differences were found concerning patients baseline characteristics. Hub group selected more often primary liver cancers versus benign lesions and liver metastasis more frequent in the Spoke group. All peri-operative data were superimposable except for blood transfusion, Pringle maneuver and length of hospital stay that were more frequent in the Hub group. We can conclude that the treatment of liver cancers in peripheral centers is possible, safe and effective especially under a H&S. There are some requisites to be successful like experienced surgeon(s), interdisciplinary meetings to discuss and minimum requirements in each hospital such as Intensive Care Unit, interventional radiology and emergency facilities.